Uterine rupture is a rare but nevertheless potentially catastrophic complication that can occur in pregnancy.
The incidence rate in pregnancy is at 0.05% 6.
Uterine rupture is usually an acute presentation with hemodynamic instability and abdominal discomfort.
The most common cause (>90%) of uterine rupture is an old Cesarean section (CS) scar. Uterine rupture may be limited to dehiscence of the ends of the Cesarean scar with an intact overlying serosal layer. A full-thickness uterine rupture with direct communication of the uterine and peritoneal cavities results in massive hemoperitoneum, and carries high fetal and maternal morbidity and mortality. Classic scars are more likely to rupture before labor, whereas lower uterine segment scars (LUSCS) tend to rupture after labor.
In general uterine ruptures tend to favor the anterior lower uterine segment, especially when associated with pregnancy.
Reported sonographic signs of uterine rupture include:
- identification of the protruding portion of the amniotic sac
- endometrial or myometrial defect
- extrauterine hematoma
- hemoperitoneum or free fluid
Multiplanar MR imaging offers a comprehensive assessment of the uterine wall and the peritoneal cavity.
Treatment and prognosis
Uterine rupture is most often an obstetric emergency (especially if associated with pregnancy). Hysterectomy is often required as part of management.
- 1. Kaakaji Y, Nghiem HV, Nodell C et-al. Sonography of obstetric and gynecologic emergencies: Part I, Obstetric emergencies. AJR Am J Roentgenol. 2000;174 (3): 641-9. AJR Am J Roentgenol (full text) - Pubmed citation
- 2. Eller AG, Fisher B. Images in clinical medicine. Diagnosis of uterine rupture on CT. N. Engl. J. Med. 2009;360 (2): 170. doi:10.1056/NEJMicm075079 - Pubmed citation
- 3. Shore E, Kingdom J, Windrim R. Spontaneous uterine rupture. J Obstet Gynaecol Can. 2009;31 (5): 395, 396. - Pubmed citation
- 4. Vadnais M, Awtrey C, Pedrosa I. Breaking point: magnetic resonance imaging evaluation of an obstetric emergency. Am. J. Obstet. Gynecol. 2009;200 (3): 344.e1-3. doi:10.1016/j.ajog.2008.09.002 - Pubmed citation
- 5. Hruska KM, Coughlin BF, Coggins AA et-al. MRI diagnosis of spontaneous uterine rupture of an unscarred uterus. Emerg Radiol. 2006;12 (4): 186-8. doi:10.1007/s10140-005-0449-5 - Pubmed citation
- 6. Eurorad teaching files : Case 9132